Paediatrics: Common presentation: wheeze

Common presentation: wheeze

Wheeze is a breath sound that is heard during expiration. It is often associated with prolongation of the expiratory phase of the breathing cycle. Wheeze indicates obstruction to airflow within the thorax. It can be high- or low-pitched; this differentiation indicates that the obstruction is likely to be in the smaller and larger airways, respectively. Also, wheezes can be monophonic or polyphonic; identifying these sounds will tell you whether the obstruction is likely to be in one or multiple airways.

Differential diagnosis

Extrinsic lower airway compression

·Lung parenchyma: e.g. pneumonia, pulmonary oedema, bronchogenic cyst.

·Vascular: e.g. enlarged left atrium compressing left mainstem bronchus, pulmonary artery vascular ring.

·Lymphatic: e.g. enlarged hilar lymph nodes.

·Chest deformity: e.g. scoliosis.

Intrinsic change in lower airway dimension

·Bronchiolitis.

·Asthma.

·Bronchitis and bronchiectasis.

·Cystic fibrosis.

·Ciliary disease.

·Haemangioma.

·Polyps.

·Tracheobronchomalacia.

Intraluminal lower airway obstruction

·Aspiration of food or milk from gastro-oesophageal reflux.

·Foreign body inhalation.

·Mucus, pus, and blood.

Each of the conditions in the list above will require specific investigation and treatment. Wheeze due to asthma will require both acute and chronic treatment.